evrazkarЕвразийский Кардиологический ЖурналEurasian heart journal2225-16852305-0748Евразийская ассоциация кардиологов10.38109/2225-1685-2018-4-98-117evrazkar-312Research ArticleКЛИНИЧЕСКИЙ СЛУЧАЙCLINICAL CASEСИНДРОМ СДАВЛЕНИЯ СТВОЛА ЛЕВОЙ КОРОНАРНОЙ АРТЕРИИ ПРИ ЛЕГОЧНОЙ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ. ПЕРВЫЙ КЛИНИЧЕСКИЙ ОПЫТLEFT MAIN CORONARY ARTERY COMPRESSION SYNDROME IN PATIENT WITH PULMONARY ARTERIAL HYPERTENSION. FIRST CLINICAL EXPERIENCEБыковА. Н.BykovA. N.

врач-кардиолог

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г. Екатеринбург, 620043, ул. Репина 99А, кв. 30

cardiologist,

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Apartment 30, 99A Repina Street, Yekaterinburg, 620043

sashacor83@yandex.ruАрхиповМ. В.ArkhipovM. V.

заведующий кафедрой терапии ФПК и ПП, д.м.н., профессор, 

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Head of the Therapy Department, Faculty of Advanced Training and Staff Retraining, holder of habilitation degree in Medicine, Professor, 

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markhipov55@mail.ruКлимушеваН. Ф.KlimushevaN. F.

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Deputy Chief Physician for Treatment, holder of habilitation degree in Medicine

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klimusheva@okb1.ruИофинА. И.IofinA. I.

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Head of Cardiology Department, honored doctor of the Russian Federation

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iofin@okb1.ruГБУЗ Свердловской области «Свердловская областная клиническая больница №1»РоссияState Budget Healthcare Institution of Sverdlovsk region "Sverdlovsk Regional Clinical Hospital #1"Russian FederationФГБОУ ВО «Уральский государственный медицинский университет Минздрава России»РоссияUral State Medical University of Russian Ministry of HealthRussian Federation2018301220180498117Copyright © Быков А.Н., Архипов М.В., Климушева Н.Ф., Иофин А.И., 20182018Быков А.Н., Архипов М.В., Климушева Н.Ф., Иофин А.И.Bykov A.N., Arkhipov M.V., Klimusheva N.F., Iofin A.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.heartj.asia/jour/article/view/312

Боль в груди является частым симптомом у пациентов с легочной артериальной гипертензией (ЛАГ). Компрессия коронарных артерий является редким осложнением ЛАГ, что иногда является причиной стенокардических болей у пациентов с ЛАГ в стадии прогрессии заболевания. Стеноз ствола левой коронарной артерии (ЛКА) расширенным стволом легочной артерии зачастую ассоциирован со стенокардией, при этом общепринятых подходов к диагностике и лечению данного состояния в настоящее время нет. В данной работе представлен клинический случай пациентки (38 лет) с диагностированной идиопатической ЛАГ, у которой наблюдалась ишемия миокарда ввиду сдавления ствола ЛКА расширенным стволом легочной артерии. Синдром стеноза ствола ЛКА был подтвержден по данным коронарной ангиографии и мультиспиральной компьютерной томографии. Стентирование ствола ЛКА и применение ЛАГ-специфических препаратов (с целью фармакотерапии ЛАГ) позволили существенно улучшить состояние пациента, включая улучшения функции сердца и качества жизни. Чрезкожное коронарное вмешательство, по-видимому, является эффективным и безопасным методом коррекции синдрома сдавления ствола ЛКА расширенным стволом ЛА.

Chest pain remains a common complaint in patients with pulmonary arterial hypertension (PAH). Compression of the coronary arteries is rare and probably underestimated syndrome being a typical cause of angina pectoris in patients with severe pulmonary arterial hypertension. Compression of the left main coronary artery (LMCA) by an enlarged pulmonary trunk is oftentimes associated with angina pectoris, but appropriate approaches to diagnosis and treatment remain poorly defined. This is a clinical case of a 38 years-old woman with idiopathic pulmonary arterial hypertension (IPAH) who has suffered from myocardial ischemia due to compression of the LMCA by a pulmonary artery aneurysm. The diagnosis of LMCA compression was made by coronary angiography (CA) and multispiral computed tomography (MSCT), which confirmed the pulmonary artery aneurysm as a source of external compression. LMCA stenting and changing in the PAH-specific therapy led to a significant improvement in angina, heart function and quality of life. Percutaneous coronary intervention appears to be feasible, safe and effective treatment for patients with external compression of the left coronary artery from pulmonary artery enlargement.

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The authors declare that there are no conflicts of interest present.